As the well known baby boomer generation surges toward retirement age, the issue becomes more significant each day of how this generation of 78 million seniors will be able to remain as independent as possible while increasingly burdened by the onset of multiple, chronic, medical conditions and a decline in cognitive abilities. Concurrent with the dramatic increase in the numbers of seniors with disabling conditions, the Medicare system is expected continue to reduce services due to economic conditions and budgetary constraints. Additionally, the rate of demand for professional health care and direct-care workers is expected to dramatically outpace supply over the next decade. Consequently, community-based care of seniors with disabilities will be more and more in the hands of the individuals themselves and their family caregivers receiving limited guidance from professional care organizations. One of the biggest issues that face home care agencies is the lack of consistency in care giving caused by an inexperienced or changing caregivers and the high cost of home visits to monitor health plan compliance. The result of these inadequacies is that all too often many seniors with disabilities are prematurely moved to more restrictive, expensive and institutional living environments that would not be necessary if home health care was provided in a more consistent manner with predictable quality. One approach to help avoid premature removal from community living arrangements is to use new technologies to help improve self-directed personal health care compliance along with remote health monitoring tools for professional caregivers to enable seniors to "age in place" while maximizing quality of care for seniors with disabilities. Therefore, in this project we will develop HealthCare Manager, a personal healthcare support system using powerful mobile computer devices to make it easier for seniors to perform personal health care activities, such as knowing when and how to take medications or comply with therapy routines, and to track health care actions that have been completed. This innovative approach will help enable elderly individuals to "age in place," maximize the consistency and quality of self-care, and avoid premature relocation to institutional settings. This approach uses new technologies to help seniors engage in self-directed personal health care while also employing remote health monitoring tools for caregivers and health professionals. Specifically, the proposed HealthCare Manager system is a portable health care support system that provides time-based prompting along with recorded audio, video and picture-based instructions for each component of a home health care regimen. HealthCare Manager offers an essential, consistent, central source of information on the specific services to be provided to each individual, and will provide interfaces for remote monitoring. The task structure for project completion includes 1) preliminary system requirements development, 2) prototype design and development, and 3) field testing in partnership with the Westchester Institute for Human Development to determine the technical merit and feasibility of the approach offered by HealthCare Manager for improving the consistency and accuracy of self-care by seniors and family caregivers, therefore reducing stress and fatigue experienced by family health care providers. Finally, the ability for the system to improve remote monitoring and schedule update capabilities of health care professionals providing oversight to the senior's personal health will be assessed. PUBLIC HEALTH RELEVANCE: This project will result in the HealthCare Manager, a software system for improving consistency and quality of implementing home health care regimens for seniors living in their own homes. The system will consist of a simplified player module used by seniors to receive notification of scheduled health related activities such as taking medications and performing home health therapies, and a web based module to allow caregivers to 1) remotely update the schedule and multimedia instruction sets used by the senior, and 2) to receive health care regimen adherence feedback. A prototype system will be developed in Phase I and tested with 32 subjects by AbleLink's project partner, the Westchester Institute on Human Development.